Lip augmentation via hyaluronic acid-based fillers can add volume and/or enhance the shape of the lips to create a pout that best flatters your face. It’s a quick and temporary procedure (results last six to 12 months) with minimal downtime (save for a bit of swelling and bruising) that can immediately and dramatically improve the smile and the overall proportions of the face. But no aesthetic treatment is without risk, and lip enhancing procedures via filler are under more scrutiny than ever before for migration – or what TikTok calls “the filler mustache.” And the number of videos about fillers seemingly moving out of place proves it's more common than many of us realize.
In these clips, lip filler patients show how the product has moved into a space in the lips near the white roll (the small white line at the top of the lip) due to poor injection technique, too much product, the lip's natural anatomy, or the wrong filler. The effect can happen in other areas of the face too – like under the eyes – but the lips are especially prone to experiencing this spreading effect. Once the filler shifts out of place, the lip (often the top one) appears duck-like or distorted, which is a look no one wants.
If you’re questioning whether your filler is migrating, here’s everything you need to know to look for and how to restore a more natural-looking appearance.
Why Filler Migrates
Hyaluronic acid-based fillers are gels with a liquid-y formulation. The basic rules of science tell us that any liquid can move. However, migrating filler isn't necessarily an immediate effect. Instead, it’s one that happens gradually over weeks, if not months or even years. All ‘temporary’ fillers aren't necessarily temporary, and some mysteriously stay in these particular areas, says Paul Jarrod Frank, MD, a board certified dermatologist and founder of PFRANDMD in New York City. The filler can move in virtually any direction, although it usually transpires more in the upper lip because of constant movement and motion (think: smiling and talking). As a result, there can be a strange appearance to the upper lips with visible product sitting in the area right above the lip, which causes it to protrude outward.
When fillers shift out of their intended place, the result is unnatural-looking lips that jut out or look fuller in unexpected areas, says Samuel Hahn, MD, a double board certified facial plastic and reconstructive surgeon in Cockeysville, MD. The displacement also often gives the appearance of bulging or excessive fullness above or below the pink portion of the lip called the vermillion border, which causes a prominent shelf or unnatural roll. In addition, some types of filler are more apt to push up into that white space than others.
So, how can someone know if their fill has migrated or if it's just a case of bad lip injections? First, look at the border of the lip and if it lacks a crisp perimeter between the lip edge and above or below the lip border or a distended area across the upper lip cutaneous (vermillion border and philtrum), says Madhuri Chadha, MD, the founder of Chadha MD Aesthetics in Beverly Hills. “This is what gives the effect of 'trout pout,’” she adds. Other indicators to look for include the appearance of prolonged swelling or difficulty closing the lips. If the white part of the lip looks like a duckbill, then the filler has shifted and it's not over-projection, adds Ava Shamban, MD, a board certified dermatologist in Santa Monica, CA.
Filler can migrate for one or more reasons. The most common include:
1. Bad Placement
Migrating filler can happen when injectable products are placed into the wrong plane. As Dr. Hahn explains, a thin plane – known as the pars marginalis and pars peripherals – separates the lip muscle (orbicularis oris), and injecting it into the wrong plane can allow the filler to move. By placing more product into the lip, the path of least resistance for the filler is into the lip's peripheral tissues, leading to a deviation, he adds. Therefore, the depth of the filler placement and the needles used are essential to a successful outcome.
Depending on where the filler is injected, it can “migrate” into the white roll and even further into the cutaneous or white lip, Dr. Shamban says. “So, the truth is, the product doesn't usually ‘migrate’ but results outside the area, which is more about not placing it into the tissue at the location or depth it should be,” she explains.
Injectors use many techniques to inject the lips depending on the look a patient wants, their natural lip shape and volume, and the inherent structure of the lips. Some buzzy injection techniques, like tenting and Russian lips, which create more volume in the middle of the lips for a heart-shaped appearance, promise to limit the incidence of displaced filler. However, there's no foolproof method other than being mindful of how and where to place the product. “The result of lip injections is directly related to the technique and the original shape and size of the lip,” Dr. Shamban notes.
Filler migration can also occur by over-injecting the lips. Movement can happen if too much filler is placed at once. Though no set amount causes a migrating-like effect – even small amounts can shift – it's best to stage out significant volume enhancement over time. But, as Dr. Frank explains, the features on the face are not that different than something like our shoe size. You can only fit so much into a specific space. “People expect to do more with filler than can be accomplished with their natural anatomy,” he says. “Overfilled lips, nasolabial folds, and cheeks are due to overaggressive filler.”
Injecting too much product into the lips forcefully stretches them out to accommodate the additional volume. Since the tissue can’t hold the filler properly, it starts getting into the neighboring areas. Injectors can control how much filler is going into any area, which is why it’s essential to take a less-is-more approach. Dr. Shamban says that using specific techniques, like microdosing the lips over several appointments, allows the product to adapt to the tissue. “We can assess the lip architecture to improve the look and appearance of size and shape or build the structure around the lips for more of a 3D appearance without overfilling the lips,” she shares.
3. The Wrong Product
Not all fillers are the same, and using the wrong product can allow it to shift beyond the placement area. Your injector must use the appropriate filler to ensure that it stays put. For starters, only hyaluronic acid-based fillers belong in the lips — never Radiesse® or Sculptra®. When it comes to HA, “there is no best hyaluronic acid filler, but there are ones that are more amenable to certain areas of the face to reduce lumping, bumping, and migration,” Dr. Frank notes.
Inflammation can occur as a natural response to injecting a foreign substance into the face. While an inflammatory response isn’t as common as poor technique or too much product as the reason behind filler that extends beyond the lips, it can happen. “There can be temporary inflammation, swelling, or a hematoma at the injection site,” Dr. Shamban says. Additionally, “it can also be attributed to a patient's reaction or an allergy to a filler, although this is rarer and an autoimmune response,” Dr. Chadha adds.
The bulging effect is most evident when smiling or puckering the lips, but it can also be noticeable when the mouth is at rest. Some patients complain of a stretched-out feeling accompanied by discomfort depending on where the filler has moved. Although drifting filler is often more cosmetic than anything, Dr. Chadha says it’s important to address it quickly if certain symptoms are present. “Look for changes in color, skin-blanching, pain, increased pressure, and continued swelling, all of which can cause concern and should be addressed by a medical professional,” she says. If the provider is not well trained, practicing proper protocol, or ensuring a sanitary environment, Dr. Shamban says infection is also a concern.
How to Fix Migrating Filler
There are two ways to fix migrated fillers:
- Dissolve them with hyaluronidase
- Wait for them to break down and dissipate on their own
For a number of reasons, the former is usually preferred. Dr. Frank says the best way to deal with migration is to dissolve the filler with hyaluronidase (an enzyme that breaks down hyaluronic acid gels). In just a few hours, hyaluronidase softens the filler and returns the lips to a more natural shape, projection, and size. Not all of the filler necessarily needs to be removed. If it's just one area that shows signs of migration, it can be spot treated. Depending on the amount of movement, the lips may need to recover before injecting them again (if you decide to) to prevent it all from happening again. For most, that’s a four- to six-week process. Patients that opt to dissolve and refill their lips need to go slow and avoid overfilling, “as this will open up the previous tissue planes that allowed for migration,” Dr. Hahn cautions.
Filler will naturally degrade for patients who do not wish to dissolve with hyaluronidase. Needless to say, this is a much longer process because the body may not entirely break down all of the product in the lips. It can take, on average, anywhere from six to 12 months to dematerialize. Going this route doesn’t mean every last drop of filler will be gone.
Migrated filler can be a one-off experience for some people and a constant problem for others. “That means you may have to consider not treating that area with filler,” Dr. Frank says. “There are people who have a naturally higher propensity to migration due to their anatomy.” You may also want to look for a better-trained provider, as Dr. Shamban suggests. “Sometimes, the area around the lip needs to be filled for structure rather than the lip itself,” she notes. A skilled injector can make significant differences and improvements with the proper support structure.
Can Filler Migration Be Prevented?
There is no perfect solution, but the best way to make sure that lip filler stays where you want it to is to be injected by a highly skilled provider who specializes in the procedure. “Generally, be concerned about your provider's experience level,” Dr. Shamban says. “The best practice is to do your due diligence and research your injector.” That includes their training and body of work. “Their aesthetic approach and results should be individualized and aligned with your look and aesthetics,” she notes.
While choosing the right provider is, first and foremost, key to a successful outcome, there are other factors to be aware of when it comes to minimizing the potential for filler migration:
- Understand what your injector is putting into your lips. The only appropriate type of filler to inject into the lips is hyaluronic acid-based product, like those within the Juvéderm® and Restylane® families. Although many different injectable brands exist, only HA fillers are safe for this area. Biostimulatory injectables, including Radiesse® and Sculptra®, do not belong in the lips.
- Appropriate filler viscosity plays a role. Using the wrong filler in the wrong plane of the lips can cause the product to shift. “The viscosity and density of the filler are important,” Dr. Hahn says. “In general, less dense, less viscous fillers are less likely to migrate.” Only your provider (not you) will know what filler best suits your lips.
- Take a less is more approach. If you want fuller lips than what genetics blessed you with, a slow and steady approach is always best. “It is better to do little bits at a time rather than overstuff an area,” says Dr. Frank, who also suggests that injectors be attentive to make sure the patients' expectations are appropriate. “Follow-up and retreatments are beneficial,” he shares. “It's also helpful to check in with patients every few months anyway to assess the work done whether they are getting refilled or not because even the best placement of filler sometimes does change in terms of positioning.”
- The injection technique is paramount. Probably the most crucial rule for your injector must follow is product placement. Dr. Hahn says that while the amount of filler injected plays a role, technique and placement of the filler are equally important to avoid migration. For example, he says it's essential to inject filler close to or at the vermillion border, which precisely outlines the cupid's bow. Otherwise, the filler can migrate into the surrounding tissue. “In general, there is an increased chance for filler migration as you inject more filler,” he adds.
If migrating filler becomes a recurring issue or you are looking to avoid the threat all together, there are other surgical and non-surgical lip-enhancing procedures to consider:
- Lip Lift: The trending lip lift procedure is a permanent way to enhance the lips. The procedure shortens the length between the upper lip and nose to show more of the pink part of the lips. Keep in mind that addressing the shape of the lips is more the objective here than adding volume, which your surgeon can accomplish by adding fat during the surgery.
- Lip Flip: A lip flip utilizes neuromodulators (i.e. Botox®) rather than filler (although many injectors choose to combine the injectables). Dr. Shamban says lip flips can be done in a similar but different way to improve lip size and shape. By relaxing the muscles around the lips, the lips flip (hence the name) out to make them a little poutier. The technique is also helpful for those with thin lips or a gummy smile.
- Fat Transfer: Autologous fat can be used to add volume and fullness to the lips when they’re inherently thin, prone to migrating filler, or just not as responsive as you’d like them to be to synthetic injections. Lip augmentation with fat transfer is usually performed alongside other surgical procedures (like a facelift), since liposuction on a donor site must first be performed to harvest the fat. After the initial absorption period, the results are long-lasting and the shape and volume can be corrected.
If you think your lip filler is on the move – be it days, weeks, months, or years after your injections – you may not be imagining it. Fillers that are incorrectly injected or not suitable for the lips can end up migrating outside the vermillion border, resulting in a ‘trout mouth’ or ‘duck lip’ appearance. While there is no surefire way to prevent this from happening, choosing an expert injector is one of the best ways to ensure an optimal outcome.
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